Case History – Indagini strumentali in pazienti con disordini temporomandibolari

Surface electromyografy of masticatory and neck muscles in patient with temporomandibular disorders and headeache: a case report

Articolo a cura del Dott. Salvatore Novi (1) e della Dott.ssa Lidia Savi

Background: Headeaches and temporomandibular disorders (TMD) are highly prevalent conditions that frequently co-exist in the same patient often associated whit myofascial pain of masticatory, pericranial and neck muscles and dental occlusion alterations.In order to determine the correct management and treatment , clinical examination should be coupled whit functional assessment. Surface electromyography(sEMG) can make an objective recording of the masticatory and neck muscles function and disfunction induced by dental occlusion as possible cause or aggravation factor of TMD associated with headeache before and after treatment.

Case report: Woman 53 years old affected by Chronic tension-type headeache ( according to ICHD3- beta criteria ) with pericranial tenderness and TMD whit myofascial long lasting pain, dental occlusion alteration, dual bite and bruxism , was submitted to sEMG. To verify the neuromuscolar equilibrium induced by dental contact , the standardized sEMG activities of right and left anterior temporal, masseter and sternocleidomastoidal (SCM) muscles were recorded during maximum voluntary clench.

Before treatment, sEMG data show an increased and more asymmetric standardized activity of their temporalis anterior muscles and anterior position of occlusal barycentre, presence of right mandibular torque ( precontact dental ), asymmetric activities of SCM with cervical load and dercreased muscle work values compatible with pain and muscolar fatigue probably as a consequence of nociceptive imputs.

After one month with treatment combining drugs, stabilization appliance and couseling, there was the complete remission of muscle symptoms and a news sEmg objective the normalization of all indexes to confirm successful outcome of the therapy.

Conclusion: sEMG , joins a set of clinical and morfological test, allow to object to any relationship between clinical symptom (pain related to muscles and palpation) and dental occlusion on masticatory and neck muscle activity in TDM associated with headeache.

(1) Esercita la libera professione in Milano e Provincia e in Alto Adige dove si occupa di Protesi, Gnatologia e trattamento dei pazienti disfunzionali nel rispetto del sistema posturale. Ѐ responsabile dell’Ambulatorio di Gnatologia e Dolori oro-facciali U.O. Maxillo Facciale, IRCCS Istituto Ortopedico Galeazzi Milano.